Inspection on 27/10/08 for Rosebery House

This inspection was carried out on 27th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rosebery House 01/05/08

Rosebery House 03/05/07

Rosebery House 10/04/06

Rosebery House 20/02/06

Rosebery House 14/12/05

Rosebery House 21/06/05

Rosebery House 30/11/04

Rosebery House 18/05/04

Rosebery House 02/12/03

Rosebery House 10/06/03

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

CARE HOMES FOR OLDER PEOPLE Rosebery House 2 Rosebery Avenue Eastbourne East Sussex BN22 9QA Lead Inspector Gwyneth Bryant Unannounced Inspection 09:30 27 October 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosebery House Address 2 Rosebery Avenue Eastbourne East Sussex BN22 9QA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01323 501026 01323 511124 hilenshah@aol.com Spemple Ltd Manager post vacant Care Home 30 Category(ies) of Dementia (0) registration, with number of places Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE). The maximum number of service users to be accommodated is 30. Date of last inspection 23rd September 2008 Brief Description of the Service: Rosebery House is a large, detached property situated in a quiet residential area of Hampden Park in Eastbourne. Local shops and amenities are a short walk away. The home is registered to provide residential care to thirty older people with dementia. Single bedroom accommodation is provided on two floors. Level access is provided by way of a passenger lift. All bedrooms are equipped with a call bell and four have ensuite facilities. Communal areas consist of a large lounge, dining room and quiet seating area. A large, rear garden provides a safe and pleasant area for residents to walk in and relax. Assisted bathrooms and toilets are located on both floors of the home. The fees at Rosebery House currently range from £423.87 to £675 per week depending upon the level of assessed needs. More detailed information about the services provided at Rosebery House can be found in the home’s Statement of Purpose and Service User Guide - copies of these documents can be obtained directly from the Provider. Latest CSCI inspection reports are on display in the reception area of the home. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection carried out by two inspectors and took place in just under five hours. The purpose of the inspection was to check compliance with the requirements made at the last inspection and inspect key standards. There were twenty-six people in residence on the day of which four were spoken with. The Manager, a domestic and one carer were also spoken with. A tour of the premises was carried out and a range of documentation was viewed including care plans, personnel and medication records. This is the third inspection of the service since the last key inspection in May 2008 as at that inspection the service was deemed to be poor and subsequently statutory notices were served which were found to have been complied with at the inspection carried out on 23 September 2008. Prior to the last site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was provided and the information included in this report as necessary. What the service does well: What has improved since the last inspection? Significant improvements have been maintained to all parts of the service including care planning, meeting healthcare needs, risk assessments, handling of medication and ensuring the autonomy and dignity of people living in Rosebery is protected. Staff practices in respect of manual handling and infection control have also improved as have staffing levels and training. These improvements have resulted in a better quality service for people living in Rosebery. Following discussion with residents and their representatives those people who are the most dependent have been moved to the ground Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 6 floor rooms to ensure they can be monitored more closely and the Manager confirmed that this will be the a future policy of the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements need to be made to the pre-admission assessments to demonstrate the home can meet assessed needs. EVIDENCE: The pre admission assessments for the last two people to be admitted were viewed and while the forms included the required basic information they did not include detailed information as to how the home will meet assessed needs. One assessment had not been fully completed and this form also indicated that the individual had mild leukaemia but did not include information on how it was to be treated whilst the person was in Rosebery. There was evidence to show that the assessments were carried out prior to admission and that they were admitted on a trial period basis. The other assessment record viewed was for a resident admitted just 3 days earlier who was assessed as having low needs. As a detailed plan of care has yet to be devised it too early to judge whether this assessment is accurate reflection of needs. Intermediate care is not provided. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. All aspects of service users health, welfare and care are now identified and planned for and the administration in medication is now good which ensures people living in the home are not at risk. EVIDENCE: Four care plans were viewed in conjunction with daily notes, medication charts, pre-admission assessments and risk assessments. Overall, the improvements noted at the September visit had been maintained and therefore the needs of residents had been identified and care plans included direction to staff in how best to meet care needs. Care needs and assessments are now linked both within the care planning systems and line with other information such as falls guidelines and challenging behaviour. Nutritional and oral health assessments are carried out and systems are in place to ensure these needs are met. It was particularly good that the home is attempting to ensure residents have access to both private and NHS dentists which further enhances their choice. There was Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 10 evidence to demonstrate that care plans are reviewed monthly with visits from GPs, district nurses and other healthcare professionals recorded and linked to relevant parts of the plans. These measures give a more holistic approach to care needs and how best to meet them, thus providing a good quality service to all residents. Daily notes had improved for the most part although some still gave limited information as to how individuals spent their day. The Manager is aware of this and is working with staff to ensure improvements achieved. Residents are weighed monthly but more often if they are of low weight and care plans include direction to ensure good nutritional intake is maintained with supplements if necessary. There were some minor errors in the care plans that indicated the generic format may be generic in practice. This was discussed with the Manager who agreed it was something that needs to be closely monitored to ensure care plans are relevant to the individual. During the tour of the premises one person was spoken with and the carer said the person was deaf and it was evident they were distressed at being unable to hear what was being said. The summary details in their care plan showed they were recorded with having total deafness but it was not clear where this diagnosis has come from. There was no record of audiology appointments or assessment for hearing aids. This was discussed with the Manager who stated that they had taken no action due to the wishes of the persons next of kin. The outcome was that the Manager was reminded of their duty of care and a GP appointment for was made during course of inspection to review hearing. The storage and administration of medication were found to be satisfactory. Medication administration records were clear, accurate and up to date. All staff who administer medication have received up to date training and the Manager monitors practice to ensure competence is maintained. Care plans include information on the triggers for medication that is as required. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lifestyle experience by people living in the home matches their expectations, choice or preferences. EVIDENCE: The Manager confirmed that an Activity Co-ordinator usually comes into the home on weekday afternoons but is currently on holiday, so carers are providing some activity sessions. The Manager said she is in the process of devising an activity programme and researching specific training in this matter. Although there were no planned activities on the morning of inspection it was good to note that music was being played as opposed to television and overall the atmosphere of the home was relaxed. Work is on-going to develop life histories for each resident to give an insight to their background which will facilitate meeting current needs. It was good to note that residents were able to get up and have breakfast at times of their choosing. Preferred daily routines are now clearly recorded in care plans with flexible times for getting up such as between 7 and 8am which provides staff with guidelines rather than rigid directions. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 12 The Manager has produced a new menu plan which incorporates five portions of fruit and vegetables each day and she confirmed that she has altered some of the ordering and fresh butter and wholemeal bread has replaced brown bread and margarine. Residents are able to have a cooked breakfast each day if they wish and it was noted that some residents had a cooked breakfast on morning of the inspection. The menu board on display in the lounge reflected the meal being prepared in the kitchen with the lunchtime meal being steak and mushroom pie with mashed potatoes, green beans and swede. Residents are offered fruit each day as a snack which is in addition to the biscuits and cake offered with tea and coffee. Homemade cakes are also being baked and these were sampled by the inspectors and found to be delicious. Food stores were inspected and it was good to note that all food decanted into plastic containers now include a use by date and there was plenty of fruit and vegetables available. All food was covered as required and none was out of date. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure with evidence that people are listened to and concerns are acted upon; people are further protected by satisfactory safeguarding adult procedures. EVIDENCE: Information in the AQAA demonstrated that the home has detailed policies and procedures on both complaints and Safeguarding Adults. The complaints log included a complaint that was made to the CSCI, which was referred to the Registered Provider for investigations, and this was recorded appropriately. The complaints log is now included in the monthly audit as a means of ensuring systems can be developed to reduce future complaints. There was a minor incident in the lounge that was witnessed by the inspectors and it is good practice to record all such incidents to ensure that such situations are avoided. However, it was good to note that staff responded to the incident in line with the information in the residents care plan. At the time residents were left unsupervised in the lounge and this needs to be monitored as it has been an issue at previous inspections. The monthly audit sheets and staff training records indicated that all except the most recently recruited staff have been trained in Safeguarding Adults procedures. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. All parts of the home are homely, safe, well maintained and comfortable ensuring that it is a pleasant place in which to live. EVIDENCE: A tour of the premises was carried out and a number of randomly selected bedrooms inspected. Since the last inspection the small lounge has been redecorated and table and chairs have been added so not only is it now a very pleasant area it also enables residents to eat alone or in a small group if preferred. There were no odours in the main lounge/dining areas and carpets throughout were in generally good condition. The refurbishment of the upstairs bathroom/shower room is now complete and is very clean and offers ample space for bathing residents. There was clear evidence of a programme of ongoing maintenance and renewal. Staff were seen to be using the appropriate laundry bags for the Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 15 carrying of linen around the home and gloves and aprons were available in bathrooms and toilets each of which reduces the risk of cross infection. Overall, all parts of the environment had improved and the Manager confirmed that there are regular checks carried out to ensure there are continued improvements. Bedrooms were found to be personalised to varying degrees with some rooms somewhat stark but others with the residents furniture, ornaments and photographs. Where rooms had not been personalised it was because the resident had chosen not to bring in their own belongings. Two rooms were malodorous but the odour was contained and the cleaner confirmed she had yet to clean these rooms. The presence of a weekend cleaner is noticeable as despite the inspection beginning on a Monday morning the home was clean, tidy and bins had been emptied. Eye hooks have been fitted to ensure call bells can no longer be wound round the call boxes and therefore are always within reach of residents. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. . People living in Rosebery benefit from sufficient numbers of staff with the skills and support to enable them to perform their roles effectively. Residents need to be further protected by more robust recruitment procedures. EVIDENCE: The staff rota showed that there are five carers on duty for each daytime shift in addition to the Manager, cooks, domestics, laundry staff and maintenance person. Since the last key inspection an activities person has been employed to devise and deliver a planned programme of activities. There are two night waking staff and although one night carer has recently resigned, existing staff provide cover to ensure residents receive consistent carer from people they know. A deputy manager has been recruited and the Manager confirmed this appointment has enabled her to concentrate on monitoring care practices and to support her in her role as Manager. Although residents were left unsupervised in the main lounge when the inspectors used the call bell, three members of staff responded. This demonstrates a more cohesive approach with all staff taking responsibility for responding to call bells rather than assuming that it is the responsibility of a particular carer as was the case during previous inspections. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 17 One of the domestics has had her hours increased and there is now a cleaner at weekends. These additions are noticeable in that overall the home was cleaner and odours significantly reduced. There is a comprehensive staff training programme that ensures staff have the skills and knowledge to deliver good care. There are systems in place to ensure training is updated promptly and all new staff undergo a detailed induction process to ensure they are familiar with the homes practices. Of the 15 care staff, 7 have at least National Vocational Qualification Level 2 in care and a further 2 are in the process of gaining this qualification therefore the home is on target to exceed the required 50 of staff with this qualification. Recruitment records for the last three people to be employed were viewed. One person had provided all the required documentation, one application was in the progress awaiting a criminal records bureau check and references. The third person had provided a written reference from a past employer however a written reference needs to be obtained from their last employer. In addition someone who lives at the same address as the applicant has provided the nominated character reference, therefore the Manager needs to establish the relationship between the person providing the reference and the applicant. Subsequently the Manager has confirmed that the third person did have a reference from their last employer. Their application form was incorrect in that they had listed past employers in the wrong order. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home needs to demonstrate that there are appropriate systems in place to ensure that the recent improvements are maintained and that it is now proactive in its approach towards development. EVIDENCE: Whilst the home did not have a manager the quality of the service declined and as a result the last key inspection resulted in a quality rating of poor. Since the last key inspection Rosebery House has received a lot of regulatory input and whilst the serving of the Statutory requirement Notices has led to improved outcomes, the home must now demonstrate that is a proactive rather than reactive service. It would appear that the input and expertise of the current manager has contributed to the current improvements, therefore systems need to be developed to ensure the Manager is supported to continue work on sustaining Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 19 the current improvements and ensuring the home remains well managed with all aspects of service users safety and welfare protected. The appointed manager is experienced in managing a care home and has both the management and care qualifications. Discussion with her found that she is clear on what needs to be done to ensure all aspects of the service improves, therefore it is important that she is supported in this role. She confirmed that she has begun the process to register with the CSCI and has already achieved significant improvements at Rosebery with support from her staff and the Registered Provider. Subsequent to the site visit the Manager confirmed that the registration process is almost complete. There is a comprehensive quality monitoring process in place which is used to ensure the home is run in residents best interests and that any shortfalls are quickly identified and actioned. The Manager has devised a monthly audit record and these are carried out to give an overview of all aspects of the service with clear timescales within which shortfalls need to be addressed. In addition the Registered Provider representative makes monthly unannounced visits and the subsequent reports have been made available for inspection. There is evidence to show that all staff receive regular supervision to ensure they feel supported and that their training needs are identified. Information in the AQAA demonstrated that all policies and procedures are updated annually and the Manager said that she is in the process of reviewing all policies and procedures to ensure they are specific to Rosebery and accurately reflect the services provided. The home does not manage the finances of people living in Rosebery, their families or solicitors do so on their behalf. With more detailed risk assessments and the introduction of pressure mats in individual bedrooms the number of falls in the home have reduced significantly. All staff have now been trained in fire safety and fire drills are carried out regularly ensuring neither they nor residents are at risk in the event of fire. Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 14 (1) (d) Requirement That the pre-admission document be expanded to include information as to how the home will meet assessed needs. (timescale of 01/07/08 not met). That checks are made as to the identity of referees giving character references for new staff. That the Manager continues with her application to become the Registered Manager. Timescale for action 27/12/08 2 OP29 19 (1) (a) (b) 10 (1) 27/11/08 3 OP31 27/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosebery House DS0000021246.V372889.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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